Inspection on 04/09/05 for The Limes Nursing Home

This inspection was carried out on 4th September 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

The Limes Nursing Home 16/04/08

The Limes Nursing Home 10/07/07

The Limes Nursing Home 21/11/06

The Limes Nursing Home 18/04/06

The Limes Nursing Home 05/01/06

The Limes Nursing Home 17/02/05

The Limes Nursing Home 05/08/04

The Limes Nursing Home 23/03/04

The Limes Nursing Home 02/12/03

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE The Limes Nursing Home 816 Wilmslow Road Didsbury Manchester M20 2RN Lead Inspector Les Hardy Unannounced 4 September 2005 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Limes Nursing Home F05 F55 s21648 The Limes V247510 D040905 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service The Limes Nursing Home Address 816 Wilmslow Road Didsbury Manchester M20 2RN 0161 446 2141 0161 445 9524 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Britannia Care Homes Limited Responsible Individual - Mr Andrew Robinson Mrs Ntswaki Elizabeth Moiloa Care home with nursing 42 Category(ies) of Old age, not falling within any other category registration, with number (OP) (41) of places Physical disability (PD) (1) The Limes Nursing Home F05 F55 s21648 The Limes V247510 D040905 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 1 The maximum number of service users requiring nursing care shall be 41. 2 The maximum number of service users requiring personal care only shall be 1. 3 Minimum nursing staffing levels as set out in the Notice issued under Section 13(5) of the Care Standards Act 2000 on 15 May 2002 must be maintained. 4 One named service user currently accommodated to receive nursing care is under pensionable age. Should this service user no longer require the accommodation offered by The Limes the service user category will revert to OP (old age). Date of last inspection 17 February 2005 Brief Description of the Service: The Limes is a care home providing nursing care for 41 older people and 1 for personal care. The Limes is an extended Victorian premises set in its own grounds. The home has two distinct units The Pines and The Limes. Accommodation is provided on 2 floors in the Pines (the most recent extension) and on the 4 floors in the original house (The Limes). An enclosed conservatory runs along the side of The Limes providing a bright, airy view of the grounds of the home.The gardens are laid to lawn, with sufficient car parking available for visitors and staff. The home is located within a short walking distance of Didsbury village and all its amenities. There are two local parks within short walking distance from the home. Bus stops to Manchester and surrounding areas are within 400yards of the home. There are two passenger lifts, one in each unit. The Limes Nursing Home F05 F55 s21648 The Limes V247510 D040905 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced, and took place on Sunday 4 September 2005. The Inspection started at 2 15 pm and lasted for 6 hours. During the inspection, 15 residents, 12 visitors and 7 staff were spoken with. A tour of the building was also carried out. A number of improvements from the previous report had been actioned, but a number had not. If the outstanding actions from previous reports are not carried out in the timescales given in this report the Commission for Social Care Inspection may to take further action. During this inspection only a selection of key National Minimum Standards were assessed therefore to gain the full picture of how the home meets the needs of residents, this report should be read with the previous and any future reports. What the service does well: Residents and visitors were happy with the care given at the home. The home was seen to met the needs of residents and in the words of one son “give my mother her life back.” The home is an appropriate building to deliver the care that residents need and it is kept maintained, clean and tidy. The Limes gives an appropriate standard of care by staff with a knowledge of residents needs following good assessments from which care plans to meet the needs of residents are developed. These include good risk assessments and recording of ongoing treatment. Residents privacy and dignity is maintained. One relative spoke about the home giving self-respect back to the relative. The building is well maintained with good wheelchair access and a good range of aids and adaptations appropriate for residents with a range of disabilities. The proprietor understands that employing nurses whose first language is not English can present communication problems with residents and other staff and addresses this by holding English as a second language classes in the Limes for these members of staff The Limes Nursing Home F05 F55 s21648 The Limes V247510 D040905 Stage 4.doc Version 1.40 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The Limes Nursing Home F05 F55 s21648 The Limes V247510 D040905 Stage 4.doc Version 1.40 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection The Limes Nursing Home F05 F55 s21648 The Limes V247510 D040905 Stage 4.doc Version 1.40 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 and 6 The undertaking of appropriate assessments before admission means that residents get the care that they need when admitted. The intermediate care unit provides a level of care sufficient to motivate and re-establish most residents in an appropriate environment in the community. EVIDENCE: Residents were admitted to the home following appropriate assessments. Residents admitted for long-term care had this undertaken by referring agencies and this included a funded nursing care assessment. The home also undertook their own assessment. Residents admitted for intermediate care were admitted following a full referral normally from a NHS hospital. Both these methods ensured that residents were only admitted if the homes manager was confident that the home was able to provide appropriate care for the resident. The intermediate care unit is in the Pines. Nursing staff from the home run this unit but are assisted by occupational therapists and physiotherapists from the local NHS Primary Care Trust that contract with the home for the service. Some senior nursing staff time is also supplied by the PCT. PCT staff work The Limes Nursing Home F05 F55 s21648 The Limes V247510 D040905 Stage 4.doc Version 1.40 Page 9 Monday to Friday, so the level of rehabilitation work is less intense at the weekend. Two local GP’s employed by the PCT provide daily medical sessions and a Consultant in Elderly Medicine employed by the PCT provides consultant medical cover for the unit. Residents and relatives on the intermediate care unit were very positive about the care provided and the ability of the staff to motivate and give residents a feeling of self worth and facilitate their return home or a less intensive care facility. The Limes Nursing Home F05 F55 s21648 The Limes V247510 D040905 Stage 4.doc Version 1.40 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9 and 10 Knowledgeable staff give a good standard of care to residents. Good medication control mechanisms are in place but must be adhered to at all times to ensure that residents are not put at risk. EVIDENCE: Care plans were formulated for all residents in the home using the available assessments. These plans were used to deliver appropriate care to residents and the care given was appropriately recorded. Other specialist health care professional were involved as required in both parts of the home and their interventions were recorded along with any recommendations that they made. Staff were able to fully meet the identified needs of residents. The registered nurses in the home were aware of the ongoing needs of residents and how these could be met. The procedures for the control and giving of medication are good. The recording of medication to residents is well documented. For example the records showed that in one instance a discontinued medication appeared to have been given on a number of occasions over a three-day period although it had been discontinued by the doctor. As this could put a resident at risk the The Limes Nursing Home F05 F55 s21648 The Limes V247510 D040905 Stage 4.doc Version 1.40 Page 11 manager must ensure that staff only give medication that is currently prescribed. Residents were treated with respect and their dignity maintained. One resident spoke about being treated as a person whilst another said that staff asked her how she wanted to be addressed and used her preferred form of address when talking to her. The Limes Nursing Home F05 F55 s21648 The Limes V247510 D040905 Stage 4.doc Version 1.40 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) None of these standards was assessed at this inspection. EVIDENCE: The Limes Nursing Home F05 F55 s21648 The Limes V247510 D040905 Stage 4.doc Version 1.40 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) None of these standards was assessed at this inspection. EVIDENCE: The Limes Nursing Home F05 F55 s21648 The Limes V247510 D040905 Stage 4.doc Version 1.40 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 22, 24,25 and 26 Appropriate maintenance ensures a good environment for residents and any need for special equipment for individual resident needs are met. A clean and odour free environment ensures this is pleasant for residents. The home must take further action to prevent the risk of cross infection. EVIDENCE: The home is well maintained by their own handyperson, with outside contractors used where appropriate, providing an appropriate environment for residents. The grounds are well kept and tables, chairs and umbrellas for shade were outside so that residents could sit outside when the weather was kind. The home is wheelchair accessible. Residents in wheelchairs are able to move freely around the home. The home has appropriate aids and adaptations to met the needs of residents. The need for equipment to assist with moving was recorded in assessments and care plans, as was the use of special mattresses to prevent residents developing pressure ulcers and help treat those who had come into the home with these. The Limes Nursing Home F05 F55 s21648 The Limes V247510 D040905 Stage 4.doc Version 1.40 Page 15 The home is reasonably decorated and is accommodation is appropriate to met the needs of residents. Locks have now been fitted to enable a piece of furniture to be locked so that residents can have peace of mind regarding security, and locks can be fitted to bedroom doors at residents request. There are some radiators in the home that are unprotected and residents could accidentally burn themselves on these, but the proprietor reported that work to address this was to be undertaken shortly. Water temperatures were stated to be regularly checked by the handyperson so that hot water at the tap is at a safe temperature that cannot cause accidental scalds. It is recommended that these regular checks are recorded. The proprietor had purchased a bedpan washer some time ago so that these could be appropriately disinfected between use to prevent the possible spread of infection. This machine has not been installed which is stated to be due to installation difficulties. These must be overcome and the machine installed by 1 December 2005. The home was found to be clean and odour free and one relative commented that the “home was kept clean.” The home has a number of what are called Dannicentres that contain plastic aprons and gloves for use by staff. These are made to contain 3 sizes of glove (small, medium and large). At the time of the inspection these were found to contain only medium sized gloves as the manager said this size fitted most people. The home should assess that this does not people residents and staff at risk because either gloves are too small and tear in use or are too large and fall off or ruck up. The Limes Nursing Home F05 F55 s21648 The Limes V247510 D040905 Stage 4.doc Version 1.40 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28 and 30 Though the home was staffed to at least the minimum requirements, the appropriateness of one trained nurse in the evening should be reviewed to ensure appropriate care. EVIDENCE: The number of staff on duty is at least to the minimum required by the current staffing notice. This notice requires one registered nurse on duty in the home in the evening. The proprietor must review this figure to ensure this meets the current needs of residents. The National Minimum Standards requires that by the end of 2005 care homes should have at least 50 of the carers trained to NVQ level 2. This is to ensure that residents receive care from staff trained to do so and understand their needs. The Limes has 3 carers with Level 2 and 1 further carer undertaking this. The home falls short of the requirement, however there were 5 carers working at the home who are registered nurses who trained overseas undertaking the adaptation training to register here as registered nurses. To include these in the NVQ level 2 figures the proprietor needs to demonstrate that the social care element of their previous training contained the NVQ required social care elements. The home arranges training in moving and handling, and fire safety. Other training is available and staff attend training outside of the home including training arranged by local NHS trusts. The home also arranges English language classes for staff whose first language is not English. The Limes Nursing Home F05 F55 s21648 The Limes V247510 D040905 Stage 4.doc Version 1.40 Page 17 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 33 and 38 The home is appropriately managed to ensure that residents receive the care they need. The home need to further develop mechanisms for feedback from residents and visitors to further improve care and the environment in the home. EVIDENCE: The manager is a knowledgeable registered nurse who leads a team of staff including other registered nurses who understand the needs of the residents and how these can be met. The National Minimum Standards require that by the end of 2005 the manager has an NVQ Level 4 or equivalent in management. However she is currently seeking confirmation from the university where she undertook nurse training that the management course she undertook is equivalent to NVQ level 4. If confirmation is received this should be made available to the Commission for Social Care Inspection. The Limes Nursing Home F05 F55 s21648 The Limes V247510 D040905 Stage 4.doc Version 1.40 Page 18 The home regularly undertakes quality audits (satisfaction surveys) on the intermediate care unit (the Pines) as a means of reporting on the quality of the home as perceived by residents and visitors. This must also be undertaken on the Limes to obtain the views of residents and visitors there. This will enable the home to check on the perceived level of satisfaction and act to remedy any deficiencies. This should also be reported back to those completing the questionnaire. The home undertakes appropriate servicing of equipment and facilities to ensure a safe environment for residents. The Limes Nursing Home F05 F55 s21648 The Limes V247510 D040905 Stage 4.doc Version 1.40 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 x COMPLAINTS AND PROTECTION 3 x x 3 x 2 x 2 STAFFING Standard No Score 27 3 28 3 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x x 3 x 2 x x x x 3 The Limes Nursing Home F05 F55 s21648 The Limes V247510 D040905 Stage 4.doc Version 1.40 Page 20 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. 2. Standard 9 24 Regulation 13 23 Requirement The manager must ensure that staff only give medication that is prescribed. The registered person must provide suitable lockable storage facilities for those residents who have not yet had a lock fitted, for medication, money or valuables. Keys must be provided for this facility. (Previous time scale of 01/07/05 only partially met). All bedrooms doors must be fitted with locks suited to residnts’ capabilities and assessable to staff in an emergency.(Previous timescale of 01/07/05 not met). The proprietor must ensure that all radiators and associated pipe work are protected. (Previous timescale of 01/07/05 not met). The proprietor must provide a sluicing disinfector to meet the required standard.(Previous timescale of 01/07/05 not met). The proprietor must review the evening trained staff figure to ensure this meets the current needs of residents. Timescale for action 01/11/05 01/12/05 3. 24 12, 23 01/12/05 4. 25 13, 23 01/12/05 5. 26 26 01/12/05 6. 27 18 01/12/05 The Limes Nursing Home F05 F55 s21648 The Limes V247510 D040905 Stage 4.doc Version 1.40 Page 21 7. 33 24 The proprietor must ensure that a quality assurance system is developed across the home to make certain that the home is meeting the residents needs fully. The results of audits must be fed back to residents, relatives and professionals involved with the home.(Previous timescale of 01/07/05 only partially met). 01/12/05 8. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard 24 26 28 Good Practice Recommendations The ability of residents to use locks must be assessed. The supplying of only one size of glove should be reviewed to ensure that this is meeting required needs. The social care element of the training undertaken by trained nurses undergoing adaptation training should be reviewed to confirm it meet NVQ 2 so these nurses can be included in the number of staff with this training. The manager should confirm that she has received management training to NVQ level 4 standard. 4. 30 The Limes Nursing Home F05 F55 s21648 The Limes V247510 D040905 Stage 4.doc Version 1.40 Page 22 Commission for Social Care Inspection 9th Floor, Oakland House Talbot Road Manchester M16 0PQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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